title: [Causes and pathogenesis of noma in Zinder (Niger): a socio-anthropological study].
abstract: OBJECTIVE
  Noma is a gangrenous affliction that destroys the soft and hard tissue of the face. It affects exclusively young children from developing countries. Although the risk factors (malnutrition and debilitating diseases) are known, the cause remains a topic of debate. Etiological studies have tried to identify bacterial or viral agents responsible for the illness. We examine for the first time the possibility of a link between this illness and the social practices surrounding childbirth.
  
  
  METHODS
  This study took place in Niger, where we conducted 18 ethnographic interviews with mothers from four villages. Noma was known in two villages, but unknown in the other two.
  
  
  RESULTS
  Our results show that inadequate practices related to breastfeeding, weaning, and nutritional supplementation practices are by themselves insufficient to initiate the disease, insofar as most of these practices, paradoxically, were found in the villages not affected by the disease.
  
  
  CONCLUSIONS
  The results indicate that these practices are not sufficient to explain noma. They suggest, however, that poor maternal health and nutritional status before and during pregnancy may have an irreversible negative impact on the child's overall health.
authors.affiliation: Geneva Study Group on Noma (Gesnomaa), Service of Plastic and Reconstructive Surgery, Geneva University Hospitals, Geneva, Switzerland, et Équipe MEOS (Médicament comme objet social), faculté de pharmacie, université de Montréal, 2940 chemin de Polytechnique, pavillon Jean-et-Marcelle-Coutu, Bureau 3177, H3T1J4 Montréal (Québec), Canada.
authors.forename: A
authors.initials: A
authors.lastname: Wamba
mesh_terms: D001628:Beverages; D001903:Bottle Feeding; D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D009548:Niger; D009625:Noma / Q000453:epidemiology / Q000209:etiology*; D009910:Oral Hygiene; D012307:Risk Factors; D018599:Witchcraft
keywords: Niger; Noma; and nutritional status; social risk factors; socio-anthropology